Example

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EEOICPA Dose Reconstruction Telephone Interview 

 Claimant is Covered Employee 

As you may know, NIOSH is responsible for estimating the occupational radiation doses received by 

persons with cancer applying for compensation under the Energy Employees Occupational Illness 

Compensation Program. Our contractor, Oak Ridge Associated Universities (ORAU), will be 

conducting the interviews. 

This interview provides you with the opportunity to inform NIOSH of any additional information 

regarding your work history that might not be contained in the exposure monitoring information we 

receive from the Department of Energy (DOE) or Atomic Weapons Employer (AWE). While we 

encourage all claimants to participate in the interview process, participation is voluntary. Even though 

some claimants may not be able to answer all of the questions during the interview or have limited 

answers to the questions, any information provided during the interview may be useful in the dose 

reconstruction process. 

Interviews with survivors will seek more general information while the interviews with energy 

employees will contain more detailed questions. This interview should take no more than a half hour, 

although we may have to call you back for additional information. If we need to divide this interview 

into a couple of shorter calls, we can do that as well. While we believe that most dose reconstructions 

can be completed without discussing classified information, we will arrange for a secure interview for 

those claimants who believe such an arrangement is necessary to complete the interview. 
Example

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Employment History

1. What jobs have you held working for DOE, DOE contractors, or AWEs? 

Employer Supervisor’s 

Name

Job Title Start Date 

(mm/yyyy) 

End Date

START WITH THE MOST RECENT JOB AND ASK THE FOLLOWING QUESTIONS IN SECTIONS. 

REPEAT THESE FOR EACH DOE/AWE JOB INCLUDED IN THE EMPLOYMENT HISTORY. 

Detailed Work History:

2. How many hours per week did you work on this job? ______hrs/week 

3. How many hours per week did your job involve potential exposure to radiation and/or 

radioactive materials? _____hrs/week 

4. Which buildings or locations did you work in, for each of your routine duties? 

Building/Location Duties

5. Describe what you did on the job, as routine duties. 

________________________________________________________________________ 

________________________________________________________________________ 
Example

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Obtain additional details on duties, as necessary:

5.1 What types of radioactive materials were present or processed, and in what form(s) 

(solid, liquid, or gas)? Review the list below individually, as necessary. 

Radionuclide Response Isotope(s) if known Form

Tritium __Y __N __DK _____ __S __L __G 

Cobalt __Y __N __DK _____ __S __L __G 

Strontium/Yttrium __Y __N __DK _____ __S __L __G 

Technetium __Y __N __DK _____ __S __L __G 

Iodine __Y __N __DK _____ __S __L __G 

Cesium __Y __N __DK _____ __S __L __G 

Thallium __Y __N __DK _____ __S __L __G 

Lead __Y __N __DK _____ __S __L __G 

Polonium __Y __N __DK _____ __S __L __G 

Radon (progeny) __Y __N __DK _____ __S __L __G 

Radium __Y __N __DK _____ __S __L __G 

Actinium __Y __N __DK _____ __S __L __G 

Europium __Y __N __DK _____ __S __L __G 

Thorium (natural) __Y __N __DK _____ __S __L __G 

Protactinium __Y __N __DK _____ __S __L __G 

Uranium (natural) __Y __N __DK _____ __S __L __G 

Uranium(enriched) __Y __N __DK _____ __S __L __G 

Neptunium __Y __N __DK _____ __S __L __G 

Plutonium __Y __N __DK _____ __S __L __G 

Americium __Y __N __DK _____ __S __L __G 

Curium __Y __N __DK _____ __S __L __G 

Californium __Y __N __DK _____ __S __L __G 

Others 

 

___(1) _____ __S __L __G 

___(2) _____ __S __L __G 

___(3) _____ __S __L __G 

5.2 What quantities of radioactive materials were present or processed (ounces, 

pounds, kilograms, drums) over what time periods? ________________________ 

________________________________________________________________________ 

5.3 What types of production processes involving radioactive materials occurred in 

areas where you worked?_____________________________________________ 

5.4 What types of radiation-generating equipment were present or used (e.g., neutron 

devices, radiography equipment)?____________________________________ 
Example

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5.5 What specific tasks did you perform, using what types of radioactive materials (in 

what quantities), and/or radiation generating equipment?____________________ 

5.6 What exposure/contamination control measures were used to protect you? 

Measure Frequency of use

___Hoods __Always __ Sometimes __ Never 

___Glove boxes __Always __ Sometimes __ Never 

___Shielding __Always __ Sometimes __ Never 

___Other enclosures (explain) __Always __ Sometimes __ Never 

___Local ventilation __Always __ Sometimes __ Never 

___Anti-contamination clothing __Always __ Sometimes __ Never 

___ Respirators __Always __ Sometimes __ Never 

___Other personal protective __Always __ Sometimes __ Never 

 equipment (specify) 

___Showers __Always __ Sometimes __ Never 

5.7 Did you conduct your work under a radiation work permitting system? 

___Yes 

___No 

___Don’t know 

IF “NO” OR “DON’T KNOW”, GO TO QUESTION 6, IF “YES”:

5.8 During what time period(s)?___________________________________________ 

Radiation Monitoring

6. Did you or your co-workers (working in the same area as you) routinely wear radiation 

dosimetry badges? ___Yes 

___No 

___Don’t know 

IF “NO” OR “DON’T KNOW”, GO TO QUESTION 7, IF “YES”:

6.1 For which duties or in which buildings or locations, and during what time periods 

(e.g., which years) did you or your co-workers (working in the same areas as you) 

routinely wear radiation dosimetry badges? 

Building/ 

Location

Time Period Duties Wore badge 

(check = yes)

Only co-worker 

wore badge 
Example

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IF THE CLAIMANT DID NOT WEAR A BADGE, GO TO QUESTION 7, IF CLAIMANT WORE A 

BADGE: I’ll ask you several questions about badge practices. I realize that badge 

practices changed over time, so please recall to the best of your ability any changes and 

the time period that they cover:

6.2 How often did you wear your badge? 

Time Period Frequency

__________ _________ 

__________ _________ 

__________ _________ 

__________ _________ 

6.3 How often was your badge exchanged? 

Time Period Frequency

__________ _________ 

__________ _________ 

__________ _________ 

__________ _________ 

6.4 Where on your body was your badge worn? 

Time Period Body Location

__________ ____________ 

__________ ____________ 

__________ ____________ 

__________ ____________ 

7. Did you participate in a biological radiation monitoring program (urine/fecal/breath)? 

___Yes, urine 

___Yes, fecal 

___Yes, breath 

___No 

___Don’t know 

8. Do you have copies of your dosimeter badge or biological monitoring records? 

___Yes, badge 

 ___Yes, biological 

___No 
Example

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IF “NO” GO TO QUESTION 9, IF “YES” :

8.1 Would you provide copies to us? ____Yes 

____No 

IF “YES” GO TO QUESTION 9, IF “NO” EXPLAIN THE IMPORTANCE OF THIS 

INFORMATION AND ADDRESS ANY CONCERNS, AS FEASIBLE. IF THE ANSWER REMAINS 

“NO”:

8.2 Why not? _________________________________________________________ 

9. Did you routinely survey yourself (frisk) for external contamination? 

IF “NO” GO TO QUESTION 10, IF “YES”:

9.1 When did you survey yourself, before or after showering? ___ Before 

 ___After 

10. Was there general area air monitoring for radiation performed in the work environment? 

___Yes 

___No 

___Don’t know 

IF “NO” OR “DON’T KNOW” GO TO QUESTION 11, IF “YES”: 

When (over what time periods) did this occur?_________________________________ 

11. Were there any radiation surveys taken to characterize potential for external exposure? 

___Yes 

___No 

___Don’t know 

IF “NO” OR “DON’T KNOW” GO TO QUESTION 12, IF “YES”: 

When did these occur?_________________________________ 

IF CLAIMANT WORKED AT FERNALD, MALINCKRODT, OR FUSRAP, OR IF THE CLAIMANT 

RESPONDED IN QUESTION 4 THAT HE WORKED WITH RADIUM AND/OR THORIUM, ASK THE 

FOLLOWING QUESTION; IF NOT, GO TO QUESTION 13: 

12. Was there monitoring in any of the buildings or areas you worked for exposure to radon? 

____Yes 

____No 

____Don’t know 

IF “NO” OR “DON’T KNOW” GO TO QUESTION 13, IF “YES”:

12.1 Which buildings or areas? ____________________________________________ 
Example

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13. Were you ever restricted from the workplace or certain job duties because you had 

reached a radiation dose limit? ___Yes 

 ___No 

Radiation Incidents

14. Were you ever involved in an incident involving radiation exposure or contamination? 

___Yes 

___No 

IF “NO” GO TO QUESTION 15, IF “YES” ASK THE FOLLOWING QUESTIONS FOR EACH 

INCIDENT IDENTIFIED:

14.1 What happened and when?___________________________________________ 

14.2 Which radioactive materials were involved, and in what form and 

quantity?___________________________________________________ 

14.3 Which radiation-generating equipment was involved?________________ 

14.4 Where did it take place? _______________________________________ 

14.5 Who was involved? ___________________________________________ 

14.6 What actions were taken to remedy the exposure or 

contamination?_______________________________________________ 

14.7 What were your location and activities during the 

incident?____________________________________________________ 

14.8 What precautions were taken to protect 

you?_______________________________________________________ 

14.9 What types of personal protective equipment, if any, did you 

use?_______________________________________________________ 

14.10 How long were you exposed during the 

incident?____________________________________________________ 

14.11 Did you receive chelation therapy or other medical treatment as a result of 

radiation exposure from this incident? ___Yes 

___No 

___Don’t Know 

IF “NO” OR “DON’T KNOW” GO TO QUESTION 14.12, IF “YES”: 

Please describe the medical treatment you received: 
Example

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_____ Chelation Therapy 

__________________________________________Other Medical Treatment 

14.12 Did you receive biological monitoring after the incident? ___Yes 

___No 

IF “NO” GO TO QUESTION 15, IF “YES”:

14.13 What type of biological monitoring? ___whole body measurement 

___urine 

___fecal 

___breath 

14.14 Do you have records of this monitoring? ___Yes 

___No 

IF “NO” GO TO QUESTION 15, IF “YES”:

14.15 Are you willing to provide copies of these records to NIOSH? 

___Yes 

___No 

IF “YES” GO TO QUESTION 15, IF “NO” EXPLAIN THE IMPORTANCE OF THIS 

INFORMATION AND ADDRESS ANY CONCERNS, AS FEASIBLE. IF THE ANSWER REMAINS 

NO: 

14.16 Why not?________________________________________ 

Required medical screening x rays

15. Were you ever required to have medical x rays for this job, as a condition of 

employment? 

___Yes 

___No 

IF “NO” GO TO QUESTION 16, IF “YES” :

15.1 How often were you x-rayed, and over what time period(s)? 

Time Period Frequency of x rays

 
Example

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15.2 Do you have records of these x rays? ___Yes, for all x rays 

___Yes, for some x rays 

___No 

IF “NO” GO TO QUESTION 16, IF “YES”:

15.3 Would you provide us with copies of these records? ___Yes 

___No 

Other relevant information

16. Have we missed asking you about any conditions, situations, or practices that occurred 

during this job which you think may be useful to us in estimating your radiation doses? 

___Yes 

___No 

IF “NO”, GO TO QUESTION 17, IF “YES”:

16.1 Describe this with as much detail as possible, in terms of what occurred, where, 

when, for how long, and who was involved: 

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________ 

17. Are you aware of any records related to the information you have provided that may help 

us estimate your doses? ___Yes: Source/Type

___Personal Physician 

___Site Medical Records 

___Incident Reports 

___Safety Meeting Notes 

______________________Other (describe) 

___No 

IF “NO” AND THIS IS THE LAST JOB TO REVIEW, GO TO QUESTION 18. 

IF “YES” AND THE RECORDS ARE FROM A PERSONAL PHYSICIAN, ASK THE CLAIMANT TO 

OBTAIN AND PROVIDE THE RELEVANT MEDICAL RECORDS TO NIOSH.

Final Questions – Identifying co-workers and other witnesses

18. Can you name co-workers or other witnesses, such as consulting industrial hygienists or 
Example

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radiation safety specialists, who can confirm or expand upon the information you have provided 

us? 

___Yes 

___No 

IF “YES”, OBTAIN UP TO FIVE NAMES AND ANY CONTACT INFORMATION AVAILABLE:

1.____________________________ 

2.____________________________ 

3.____________________________ 

4.____________________________ 

5.____________________________